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21 October, 2005

HERCEPTIN SHAKES UP THE BRITISH HEALTH BUREAUCRACY

The drug Herceptin was yesterday hailed as a potential cure for breast cancer that will revolutionise the way the disease is treated and save up to 1,500 lives a year in Britain and many tens of thousands across the world. As an editorial in the world's most authoritative medical journal spoke of the drug's "stunning" results in trials, the Prime Minister insisted that it had to be made available in Britain more quickly.

A health authority in the West Country has become the first in the NHS to say that it will make the drug available to all suitable women with early breast cancer, even before it is cleared by regulatory authorities. The cost for a year's treatment is 21,800 pounds per patient.

The publication of trial data on Herceptin in the New England Journal of Medicine was accompanied by an editorial by a top US specialist proclaiming the results as revolutionary. The most striking finding is that the peak in recurrence of the disease in the first two to three years after surgery has been eliminated in women taking Herceptin, said Dr Gabriel Hortobagyi in the editorial. "This observation suggests a dramatic and perhaps permanent perturbation of the natural history of the disease, maybe even a cure," he wrote. "Longer follow-up will determine whether this is correct." .....

Forced on to the back foot by growing clamour from patients and cancer charities, the Prime Minister yesterday conceded in the Commons that Herceptin had shown the need to speed up drug approvals. "At present, I think we all accept the procedures are too slow," Mr Blair said. "We are looking at how we can speed that process up in cases where it particularly matters to people who may be desperately ill and think there is a drug on the market that can help them."

Currently, the drug is licensed for use only in advanced breast cancer, though doctors can use their discretion to prescribe it in other exceptional cases.

More here



British woman sells her house to pay for Herceptin in India

A breast cancer sufferer is spending more than 25,000 pounds to be treated with Herceptin by a private clinic in India. Linda Vijeh, 50, of Ilminster, Somerset, is selling her 125,000 pound house to pay for the drug. She is believed to be the first British patient to travel abroad for Herceptin. Speaking from India yesterday, she said: "Herceptin is only licensed in the UK for use where cancer has spread to other parts of the body. Well it's a bit bloody late then. "It takes some leap of faith to fly to a Third World country to be treated by a doctor you've never met in a hospital you've never heard of. That is how desperate I was."

Ms Vijeh, a former chef to the British Ambassador to the UN in New York and a Tory member of South Somerset District Council, had cancer diagnosed after finding a lump in her right breast in August last year. She was tested and found to have HER-2 positive breast cancer, the form of the disease that can be treated by Herceptin. She had the tumour removed a year ago before beginning chemotherapy in March at Treliske Hospital, Cornwall. It was there that she met an Indian doctor who referred her to a consultant in India.

After flying out on September 27 she had a mastectomy and reconstruction surgery. She is receiving one course of Herceptin in India; it will be administered intravenously during two-hour sessions every two weeks. That course is costing her 1,000 pounds and she is also paying the doctors about 17,000 pounds for a year's worth of the drug to bring back to Britain. Once home, she plans to find a private clinic to administer it

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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20 October, 2005

NEW YORK: GOVERNMENT MEDDLING KILLS OFF THE VERY ILL

In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.

At first glance, the system seems to have made an enormous difference. Although there’s no satisfying way to compare our risk-adjusted death rates with those of other states (most of which only have data from Medicare patients, who tend to be sicker and therefore skew the sample), the most recent data suggest that in the past fifteen years, New York’s coronary-bypass surgeons have improved their mortality rates to the point that they are, on average, just one-third of what they were. Sharma’s risk-adjusted mortality rate in the latest angioplasty report is an astonishing 0.1 percent, the state’s lowest. In eleven years, he has been the only doctor to have consistently earned the state’s coveted double asterisk, which designates a surgeon with numbers far below the norm. These days, plenty of his colleagues have low numbers, too; everyone has drifted downward together. Like the children of Lake Wobegon, the surgeons of New York are all, apparently, above average.

But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success records.

Today, it seems clear that this prophecy has come true. Many surgeons, simply put, began gaming the system immediately and continue to do so today. “We still have people at this hospital who will not treat a high-risk patient,” says David Brown, an angioplasty cardiologist at SUNY–Stony Brook, with evident frustration. “I see a case on Monday morning with an acute myocardial infarction”—a heart attack—“that wasn’t treated. They come in and assess the patient, they think the patient’s at risk of dying no matter what they do, so they do nothing. And people admit to it.”

This isn’t just about high-risk patients. It’s about doctors playing games with practically any patient to get better scores. Some surgeons look for ways to make their easy cases seem harder. Others make their hard cases appear so difficult that they place out of the state reporting system. When it comes to the sickest patients, some surgeons simply turn them away, asserting that they’re better off getting drug treatments, or waiting in the ICU. “The cardiac surgeons refer their patients to the cardiologists, and the cardiologists refer them to the intensive-care unit,” says Joshua Burack, a SUNY–Downstate surgeon in Brooklyn who in 1999 released a study revealing that nearly two-thirds of all heart-bypass surgeons in the state anonymously admitted to refusing at least one patient for fear of tainting their mortality rates. “Everyone’s going to pass along the hot potato to the person who’s not vulnerable to reporting.”

In the past five years, no fewer than five studies have been published in reputable journals raising the possibility that New York heart surgeons are not operating on certain cases for fear of spoiling their mortality rates. The clincher came in January, when, in an anonymous survey sent out to every doctor who does angioplasty in the state, an astonishing 79 percent of the responders agreed that the public mortality statistics have discouraged them from taking on a risky patient. If you’re a hard case, in other words, four out of five doctors would think twice before operating on you.

And consider this: Research shows that New Yorkers are more prone to dying from heart attacks than people in any other state, and the death rate from heart disease in the New York metropolitan area remains disproportionately high. There could be something wrong with our diets. It could be the stress of living here. But it’s also possible that another factor plays a part: Just as more people than ever are dying of heart disease in New York, the very system designed to make heart surgery safer here may be convincing surgeons to turn patients away.

Much more here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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19 October, 2005

GOOD OLD BUREAUCRATIC BUCK-PASSING

Even when people are dying, nobody's to blame in a bureaucracy

BUNDABERG Hospital's top bureaucrat Peter Leck has used his return to the stand at the health inquiry to deflect some of the blame for the Jayant Patel scandal, criticising his offsider Darren Keating, Queensland Health and even hospital medical staff.

Mr Leck, who initially asked to be exempt from giving evidence on the grounds of mental illness, testified from a closed court with only audio of his testimony beamed into an adjacent room at the Brisbane Magistrate's Court.

He gave evidence to the first inquiry in May. He told commissioner Geoff Davies that because he had no medical training, he relied on his director of medical services, Dr Keating, to bring any clinical issues to his attention. He said Dr Keating had repeatedly reassured him that concerns being raised about chief surgeon Dr Patel were nothing to worry about.

Mr Leck -- suspended from his general manager's position pending the inquiry's outcome – said he was under constant pressure from Queensland Health to bring the hospital in under budget and to avoid bad publicity.

But Mr Leck, who was warned last week by Mr Davies, QC, to expect rigorous cross-examination, had his own conduct spotlighted by senior counsel assisting David Andrews, SC – particularly the failure to subject Dr Patel to credentialling and privileging checks during his two-year tenure. It is a district manager's sole responsibility to ensure such checks take place.

Mr Leck said he had delegated the credentialling process to Dr Keating and had pressed him several times about the need to get it up and running. "I kept on pressing and he became a little short with me and basically said that he had a lot on his plate and that he couldn't work the hours that I worked because he had family," Mr Leck said.

Mr Leck was also questioned about why he failed to report to his superiors the death of Gerry Kemps - one of Dr Patel's patients who died after surgery in late 2004 - which was required in the event of an unexpected death.

Late yesterday senior counsel assisting, David Andrews, SC, showed the inquiry an e-mail from Mr Leck to his director of nursing, Linda Mulligan, on January 13 this year in which he said they needed to "quieten down" any potential rumours circulating about Dr Patel. Mr Leck said he wrote the e-mail in response to a group e-mail from a staffer. Mr Leck said he assumed the first e-mail referred to Dr Patel because he had told other staff about the allegations that had been made about him.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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18 October, 2005

BRITAIN: ONLY 24 YEARS TO DIAGNOSE A COMMON ILLNESS

For years Nicola Howells was told her illness was "in her head". She was just 11 months old when she had her first seizure, but it was another 24 years before doctors finally diagnosed her with epilepsy. She was sent for psychiatric treatment, told she was suffering from vertigo and panic attacks, and put on anti-depressants.

But it was not until her father died from a hereditary tumour that doctors finally scanned her and diagnosed epilepsy. And it was nearly two months before she saw a specialist.

"It got to the point that they told me it was all in my head. "My teenage years and my childhood were stolen from me. If I had been diagnosed younger, I would have come to terms with it more easily and would have learnt to take my medication, but as an adult I felt that my whole world had been rocked. "They sent me to a child psychiatrist and I was told that it was all in my head. I know so many people who have gone through so many similar scenarios.

"My mum tried to fight my corner and she is riddled with guilt because when they said it was all in my mind she began to think it was."

Epilepsy experts say Nicola's story is not uncommon. They are calling for more money and expertise to be ploughed into the UK's services. National Institute for Health and Clinical Excellence (NICE) guidance states that misdiagnosis rates for epilepsy in the UK are between 20-31%.

Patients currently have to wait between eight to 10 weeks from diagnosis until their first hospital appointment. They wait about five weeks for an EEG (to monitor electrical activity in the brain) and 24 weeks for a magnetic resonance imaging scan (MRI), which can reveal structural abnormalities in the brain. NICE standards call for waiting times of no more than a month. Neurologists, nurses and epilepsy charities say the specialty needs an investment of 150 million pounds to overcome serious gaps in the service.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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17 October, 2005

British babies fall sick as doctors ignore superbug hygiene

Newborn babies at 90% of hospitals are carrying the superbug MRSA, according to a study which found that doctors and nurses are ignoring basic hygiene measures to combat the spread of infection. Fewer than half of doctors and 63% of nurses always wash their hands with antiseptic gels between patients, says the report. In some parts of the country only a third of hospitals have cleaners at night.

The findings by the Patients Association, which cover England's 28 strategic health authorities, will be a blow to Patricia Hewitt, the health secretary, who has made tackling MRSA and other hospital acquired infections a top priority. In May Hewitt announced a code of practice for hospitals to ensure that hygiene standards are met. Katherine Murphy, director of communications at the association, said: "Washing your hands properly is not complicated. We now have alcohol foams and gels that are very easy to use. "Another basic step is ensuring that wards are clean, but our report showed that in some hospitals there is no access to cleaners in the evening. This is not acceptable. What happens if there is a blood spillage after 7pm?"

MRSA is now so rife in hospitals that in 22 of the 28 health authorities questioned babies less than one week old have been found with the bug. The infants could have contracted MRSA from their mothers, from other patients or from doctors and nurses. While most of these babies would have been carrying the bug in their noses or on their skin without it causing harm, they are at risk of it developing into an infection.

Hewitt's warning to hospital managers followed the Patients Association's Clean Hospitals Summit in April at which the actress Leslie Ash, star of Men Behaving Badly, criticised the government for failing to keep hospitals clean. Ash fell victim to MSSA, a variant of MRSA. At the two-day event the association set hospital trusts a "100-day challenge" to improve standards. At the end of August, when the 100 days were up, it carried out an investigation to find out if improvements had been made. The full results will be published at a follow-up conference in London next month.

The study also showed that hospitals are overcrowded. In 58% of hospitals bed occupancy was in excess of 95% and in 90% of hospitals the rate was above 85%. Government guidelines advise managers that it should be no more than 82%.

MRSA is now so prevalent in wards that babies of less than one week old have been found with the bug in 90% of hospitals. Last week two newborn babies had to be put in isolation at St James's University Hospital, Leeds after they were found to be carrying the MRSA bug. In February a two-day-old baby became the youngest victim to die in hospital from MRSA. Luke Day had been born healthy, weighing 7lb 7oz. But he died just 36 hours later at Ipswich hospital in Suffolk. Microbiologists said that a doctor or nurse was the most likely source of the infection.

Last December 14-week-old Connor Bull became one of the youngest known MRSA victims when he caught the infection at Leeds General Infirmary. Claire Wilkinson, his mother, had to scrub down before she could touch him. He fought off the infection after 19 weeks in intensive care.

Mark Enright, an MRSA expert at Imperial College London, expressed his disappointment at the failure of hospitals to take basic measures to improve hygiene. "If we are not even delivering on improved hand washing and cleaning of hospitals then we are not really doing very much in the fight against MRSA," he said.

Professor Hugh Pennington, a microbiologist and expert in hospital acquired infection, added: "This confirms that MRSA is a problem that affects babies and young children and not just older people and patients who have had a lot of surgery." The Department of Health said: "We expect hospitals to enforce strict standards of hygiene and cleanliness. All National Health Service trusts now have directors of infection control and teams to ensure good practice is followed. [And black is white too]

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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16 October, 2005

IMPENETRABLY BUREAUCRATIZED AMERICAN MEDICINE

When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her. There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment. When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00." On the 15th page or so of each bill, a "balance forward" line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.

Another mailing, from her insurance company, clearly said, in large type, "This is not a bill." But she could make no sense of the remark codes: "G7 - Your benefit is based on the difference between Medicare's allowable expense and the amount Medicare paid" or "QN - Your claim may have been separated for processing purposes."

Mrs. Klausner's experience is shared by millions of Americans who, frustrated and confused, find themselves devoting enormous amounts of time and energy to sorting out their medical bills. Walk into any drugstore, and the next few minutes of your life are fairly predictable. After considering the choices, you make your purchases and head for the cashier. Seconds after the transaction, you are handed a receipt that reports to the penny what you paid for each product, along with its brand, its size, and the date, time and location of the purchase. But become a patient, and you enter a world of paperwork so surreal that it belongs in one of Kafka's tales of the triumph of faceless bureaucracies. And although some insurers and hospitals are trying to streamline and simplify bills, the efforts have been piecemeal.

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.'s - are filled with unintelligible codes. The system is so impenetrable that it mystifies even the most knowledgeable. "I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."

Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer. "I understand the words of diagnoses and procedures," he said. "But codes? No. Or how things are paid or not paid? I don't understand that." Dr. Brailer said he often used an analogy to describe the current state of medical billing. "Suppose you walk into a restaurant," he said, "and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost." "Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe," Dr. Brailer said.

Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.

In the days before managed care, most insurance plans operated on a fee-for-service basis. Patients paid 20 percent of medical fees; insurers paid 80 percent. But as health care costs have continued to rise, many patients are being required to pay an ever-larger part of their medical bills, and deductibles continue to increase. And to keep the system churning, close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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15 October, 2005

THE ARROGANCE OF SOCIALIZED MEDICINE

Give the people choice

The [British] nurse who this week won her legal battle to be prescribed the breast cancer drug Herceptin has struck something of a blow for patient rights. Health authorities may claim, as they have been doing, that Barbara Clark’s win does not set a legal precedent for the 10,000 other women each year who might benefit from Herceptin but are currently denied it. In practice, however, it will be difficult for health officials around the country to deny the drug to other patients which, at a cost of about £20,000 a year, could dent a few budgets.

Never mind that. What is alarming about this case was health officials’ decision to give Ms Clark the drug owing to exceptional circumstances: she has a terminally ill 11-year-old foster son. The day the NHS officially decides to treat people according to their personal “worth”, or society’s need for them, rather than their medical need, will be the day the health service dies.

I say “officially” because in practice, of course, hospital consultants faced with long waiting lists make such judgments all the time. A child will be operated on before an 80-year-old and a smoker will be told to quit before being given a heart bypass. But those decisions are based on a calculation of future quality (and quantity) of life. In the end they are, as far as is possible, medical computations, not moral judgments about who “deserves” treatment. Is a childless person to be worth less than a mother? Which of them is more likely to be paying for the NHS? You cannot pick and choose without losing the consensus that supports the health service in the first place.

So let all have Herceptin if it would help them, even at a cost of £200 million a year. The only reason local health trusts are not able to offer the drug routinely (apart from its cost) is that it is caught up in the Government’s lengthy regulatory procedures. The manufacturer, Roche, says it has not yet collected the safety data needed to apply for a licence for its use to treat early breast cancer. Once a licence is granted, the drug has still to go through the National Institute for Health and Clinical Excellence system, which will decide whether it is sufficiently effective and cost effective to be made available nationally. In other words, okaying it will take years. Yet the data available is so persuasive that good private health insurers already pay for it.

The way we, as patients, allow the Government to dictate which medicines should and should not be available to us is overdue a rethink. The current system of regulating all medicines as prescription only, available over the counter from a pharmacist, or general sales dates back to the 1960s, when far less information was available to patients about the benefits and potential side-effects of treatments.

But patients today have acccess, via the internet, to a barrage of information inconceivable in 1968. Anyone who has a serious condition diagnosed can quickly become a patient-expert, and many do. I have one friend who discovered the expert’s expert in her disease, a doctor in the US, and rang his office. She was astonished when he actually came to the phone to speak to her, and was extremely helpful, even genuinely interested in her symptoms.

To continue to suggest that patients should be passive recipients of whatever is doled out to them by the NHS, or would become pill-popping morons without the toughest state control, is offensive. Nobody wants to take a breast cancer drug that doesn’t have a good chance of doing them some good. Few would risk the unwanted side-effects of most medicines without good evidence that it might help them. Publish all the data (and I mean all of it) and let people decide. Then let them go to a doctor if they wish to seek further advice on their decision.

The licensing system anyway ignores the fact that the full side-effects of a drug are not known until hundreds of thousands of people have taken it; look at what happened with Vioxx, a painkiller given to arthritis sufferers and withdrawn last year after it was linked to an increased risk of heart attacks and stroke. Why not set up a website for patients to record their experiences with different drugs?

I remember, years ago, being advised to take Larium, a malaria prophylactic, by a doctor. Doesn’t Larium have nasty side-effects, I asked him. Oh, it makes one in a few thousand go mad, he replied airily. One of those affected happened to be my friend, who suffered some kind of nervous system collapse and all but lost the ability to speak; and of the others I knew who had been prescribed it, all experienced frightening side-effects. I don’t care what it says on the packet. No thanks.

A Commons Health Select Committee report this year found the relationship between pharmaceutical companies and the medical profession to be too close for comfort (www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf). The Department of Health spends £4.5 million a year providing independent medicines information to prescribers; the drugs industry spends £1.65 billion, often cushioned with free trips abroad or other goodies for your doctor. Are you sure that he knows best?

Liberalising the market in medicines raises questions about cost as well as safety. But this is a debate the country is going to have to have. The cost of medicines to the NHS has risen by 46 per cent since 2000 to £8 billion a year, or 11 per cent of its budget. Keeping drugs as prescription only can work in the interests of the pharmaceutical companies, allowing manufacturers to set prices that the NHS can bear, rather than what individuals will pay. If a drug was too expensive for you or I to buy over the counter, then we would ask for something else. When the antihistamine Claritin was changed to an over-the-counter drug in the US three years ago, the price for a year’s supply fell from $1,066 to $365.

The Government has accepted the case for reclassifying more drugs “down” from prescription to over the counter, but has set an entirely arbitrary figure, up from five to ten annually. Why ten? Why not eleven? Or 111? Deregulate more of the most common drugs and give people the option of buying them rather than queueing at the doctor’s for a prescription. Giving patients more control could turn out to be healthier all round

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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14 October, 2005

CRAZY HEALTHCARE COSTS

I don't know what to make of the news item below at all. $15,897 for two X-rays sure sounds amazing. I have just phoned my local private Catholic hospital here in Brisbane and they quoted me $100 for such a service. An X-ray machine is just a big old-fashioned camera after all. Perhaps the story following the news item explains the American way. The story was in fact sent to me by an American medical specialist

A group of former patients of the California Hospital Medical Center on Tuesday filed a class-action lawsuit against Catholic Healthcare West alleging that the hospital chain overcharged uninsured patients and engaged in unfair business practices that violate California's consumer protection laws, the Los Angeles Times reports. Activist K.B. Forbes, head of the advocacy group Consejo de Latinos Unidos, organized the suit on behalf of three Latino plaintiffs. One patient stayed in the hospital for two days with gastritis and was charged $20,296.50, compared with $5,600 for the same medical care from an average private insurer and $3,994 for a Medicare beneficiary. Another patient was billed $15,897 for two X-rays of his shoulders, compared with $4,451 from a private insurer and $3,839 from Medicare (Lin, Los Angeles Times, 10/12). The suit aims to make CHW consider reforming its billing practices in California, Nevada and Arizona and reimburse the three patients, the AP/Contra Costa Times reports (Prengaman, AP/Contra Costa Times, 10/12).

Comments:
"It's price gouging," Forbes said, adding that CHW should have informed the patients of available charity care and government assistance programs. Forbes said he wants CHW to implement standards similar to those of Tenet Healthcare, which was sued in 2003 by Consejo de Latinos Unidos. Tenet subsequently started offering uninsured patients discounted rates after the suit. Forbes said, "None of these people are looking for a free ride. They are looking for a fair rate." CHW officials did not comment on the suit, but they said the company already offers free and discounted rates to the uninsured and has helped many such patients obtain state and federal coverage (Los Angeles Times, 10/12). Jan Emerson, spokesperson for the California Hospital Association, called the lawsuit "unfounded," adding, "The allegation of price gouging is absurd" (AP/Contra Costa Times, 10/12).

Source



THE CREW RACE - THE AMERICAN WAY

A Japanese company and an American company decided to have a crew race on the Missouri River. Both teams practiced long and hard to reach their peak performance before the race. On the big day the Japanese won by a mile. Afterward, the American team became very discouraged and morally depressed. The American management decided the reason for the crushing defeat had to be found. A Management Team made up of senior management was formed to investigate and recommend appropriate action. Their conclusion was the Japanese had 8 people rowing and 1 person steering, while the American team had 8 people steering and one person rowing.

So American management hired a consulting company and paid them an incredible amount of money. They advised that too many people were steering the boat, while not enough people were rowing. To prevent losing to the Japanese again next year, the American rowing team's management structure was totally reorganized to 4 steering supervisors, 3 area steering superintendents, and 1 assistant superintendent steering manager. They also implemented a new performance and productivity system that would give the 1 person rowing the boat greater incentive to work harder. It was called the Rowing Team Quality First Program, with meetings, dinners, PowerPoint presentations, and free pens for the rower. Even new paddles and medical benefit incentives were promised for a winner. We must give the rower the empowerment and enrichments through this quality program. The next year the rower rowed as hard as he could, but the Japanese won by two miles. Humiliated, the American management laid off the rower for poor performance, hired a Mexican rower replacement, halted development of a new canoe, sold the paddles, and canceled all rower medical benefits. The money saved was distributed to the senior executives as a bonus.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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13 October, 2005

SHRIEK! PATIENT CHOICE: HOW AWFUL!

Bureaucracies endangered!

NHS wards, departments and even entire hospitals may be forced to close under the latest health reforms designed to extend patient choice, the Government is warned today. In a damning report, the Audit Commission says the new funding method, where money follows the patient, is destabilising the NHS and fuelling the current financial crisis. Instead of increasing choice it could have the opposite effect, with services going to the wall unless the payment system is radically reformed, says the commission. It also cautions that critical services essential to support emergency admissions could close down in some hospitals because of the failure to attract patient referrals.

The system of “payment by results” was brought in by the Government for foundation trusts in 2004-05 to improve choice and efficiency in the NHS and is now being extended to all trusts. Commission insiders gave warning that if foundation trusts, the top- performing hospitals, were finding the system difficult to operate it would create turbulence when extended nationwide. Under the system hospitals charge a fixed price for an operation, which is agreed nationally, and claim the money back according to the number of patients treated.

Efficient, well-managed hospitals are expected to make a profit from the set price, which includes the costs of equipment and staff overheads. But weaker, inefficient hospitals risk exceeding the “tariff” and falling further into debt. NHS reforms are already causing disputes. An extraordinary battle has developed in Dorset between the primary care trust and the local hospital. GPs received a letter from the Bournemouth Teaching Primary Care Trust (PCT) giving warning that the local hospital, Bournemouth and Christchurch, was working too hard. Payment by results will mean that hospitals are paid by the numbers they treat so, paradoxically, hospitals doing well could be in trouble. “The hospital is undertaking a lot more work than we have agreed to purchase, and this is causing us a great deal of concern” wrote Debbie Fleming, the PCT’s chief executive, and Paul French, chairman of the executive committee, in a letter that has been seen by The Times. “If action is not taken now, the PCT will face a bill of around £2 million.”

The Audit Commission says that, so far, the system has proved chaotic because of poor budgeting, inadequate IT services and difficulties in predicting patient admissions. It also claims that hospitals already strapped for cash are having to invest £100,000 each in the new systems, equivalent to £50 million across England. The NHS is already facing a £254 million deficit, despite record levels of cash over the past few years. One in four NHS trusts is now in financial difficulties.

The commission advises the Government not to go ahead with plans to extend “payment by results” to emergency admissions next year without reform. Last night Howard Stoate, a Labour MP who is the only praticising GP in the House of Commons, said: “Payment by results does unfortunately have negative side-effects. There is the risk it could put pressure on some (hospital) departments where they are effectively competing against a neighbouring trust and could lose busines “There is also a risk it could destabilise and put pressure on primary care trusts because they pick up the bill at the end of the day.”

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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12 October, 2005

AND THIS IS WHAT THE LEFTIST BA****DS WISH ON US!

I recently came face to face with a level of Western ignorance that I hadn't encountered since the 1980s, when Russian immigrants were still a novelty to Americans. A British-American asked my father a question that could only come from someone who has known freedom his whole life: "Why did you leave Russia? Your family was there, you had a job, you had free health care. Why did you leave?" The questioner, a former editor with the New York Times, then proceeded to assert that today's Britain and U.S. are no longer free.

The exchange reminded me just how out of touch many who live in the free world are with the reality of life under tyranny--and why, therefore, so many Americans and Brits think nothing is scarier than war. On the subject even of that oft-cited "perk" of Soviet life, universal health care, a picture of the system in practice on its happiest occasion would shock Americans and Western Europeans alike.

Since ordinary people in Russia didn't have cars, Dad called a taxi to take Mom to the hospital when her contractions started on Feb. 25, 1970. Some procedural questions were asked, then Mom was sent to a room called the rodilka, or "birther," where there were 10 or so women at various stages of dilation. For the night there were one doctor, one nurse, a female orderly and a lot of screaming. (Epidurals for painless labor were unheard of.) At this stage of pregnancy a woman loses control of some bodily functions even after taking preventive measures, so that one woman would be defecating into a pot by her bed while another would be eating dinner in the next bed. Medical students passed by casually observing.

After my elder sister was born and the nurses took her away, Mom began the two-day fluid-expulsion process, which in civilized countries is managed by a changing of the sheets as often as every two hours. Back in the USSR, the new mother would soak in her puddles on a small linen sheet and oil cloth, since patients weren't entitled to more than one or two changes per day. If she wanted an extra change, she'd have to beg and brown-nose the nannychka, as the orderly was addressed by the screaming women. Someone would always yell back: "I just gave you new sheets, and you soiled yourself again!"

Those who were able to bribe the nurse or orderly would get better service, but Mom didn't know and hadn't brought anything. One woman kept giving the nurse fruit so that she'd yell at her less and give her what she needed. Mom could only beg, the whole time feeling as if she'd done something wrong. Granted, the nurse was under an inordinate amount of stress. She was alone responsible for so many, and was running nonstop throughout the night.

For her second delivery, Mom never went into labor. She was two weeks overdue and the baby had stopped moving. Fearing the worst, she took the metro to the hospital.

"Are you in labor?"

"No."

Again Mom thought she'd done something wrong because people were yelling at her as soon as she walked in: "Then why did you come? You like hanging around hospitals, do you?"

"I don't feel anything moving."

"Oh. OK, wait for the doctor."

Fortunately, a younger nurse overheard the conversation. "What--it's not moving? How long? Since last night? OK, go over there and get undressed."

People stopped yelling at my mother then, and she got more attention.

"I don't hear the baby," said the old doctor who was on duty. "Is this your first child?"

"No."

"Did the first one live?"

"Yes."

"Good. Because the prognosis here isn't good."

Since there was no labor activity, labor was induced. In Russia this was called "stimulating labor," and it required one to drink castor oil. My mother has its taste on her tongue to this day, she told me. Her body contorted inexplicably, and she became catatonic, unable to move her arms or legs.

She could hear the yelling at the others as it continued in the background: "Stop screaming!" "You're not the first to give birth; you won't be the last!" "Shut your mouth!" After some time, Mom's catatonia relaxed and the contractions started. A few hours later the baby was born, and my mother heard the doctor call to an orderly: "Quick! You with the water--the baby is in asphyxia!" My mother lay emotionless, able only to hear spanking for what she believes to be nearly half an hour as the doctor tried to revive me. Finally, she heard crying.

Had my mother been a party boss's relative, her birthing experiences would have looked a lot more like the common woman's in America. But such was delivery for 99% of the Russian female population.

In America, women often remember abortion as traumatic. My mother barely remembers her two abortions (Russian birth control), but she can't forget a single traumatic detail of her children's births.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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11 October, 2005

BRITAIN'S GOVERNMENT-RUN HEALTH INSURANCE LEAVES CANCER SUFFERERS IN THE LURCH

Maintaining their vast bureaucracy matters more to them than curing the sick

Joanne Lees, a pay-roll clerk, relies on the National Health Service. But, as she has discovered, deep pockets can be required here, too - particularly if the worst does occur. When she received a telephone call at work in August last year asking her to go to hospital immediately, she expected to receive bad news. But she did not expect it to be quite so awful. Lees, 31, learnt that she had a fast-growing tumour in her right breast. She had a mastectomy a couple of weeks later; but there were two complicating factors.

First, she was six months' pregnant. Her baby son Nathan had to be delivered by caesarean section 10 weeks early so that she could undergo chemotherapy and radiotherapy. Additionally, it was her second bout of cancer. She had lost her left breast when she was 26. Lees had a quiet Christmas with Nathan and her husband Sean, but thought that she might not be around to enjoy another one. She was told that the likelihood of the disease returning was 81%.

Her breast cancer nurse offered a glimmer of hope, however. Early results from clinical trials showed that a new drug, Herceptin, could reduce the chances of cancer coming back in some patients. A test showed that Lees was positive for the HER-2 gene, which put her among the 25% of breast cancer patients who could benefit from this new wonder drug. Her oncologist at the University hospital of North Staffordshire was prepared to prescribe the medicine. There was just one problem: the NHS would not pay for it.

Lees and her husband had no idea where they would find the 40,000 pounds asked for a two-year course of treatment. "We are just a normal family," she said. "Very few people would be able to pay for this medicine from savings." They were not alone, however. Family, friends, colleagues and even their local pub in Alsager, Staffordshire, have rallied round. With their help, Lees is paying for her Herceptin on a three-weekly basis. If necessary, the couple will remortgage their home to meet the next instalment.

The potential burden is enormous. If the optimistic predictions of experts are correct, Lees could be taking Herceptin, at a cost of 20,000 pounds annually, for years to come. "I don't dare think about the future. I want to be here for my little boy. All I am asking for is the chance to be there for Nathan, to see him grow up," she said.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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10 October, 2005

IN PRAISE OF AMERICAN HEALTH CARE

Twenty years of public policy research on health care recently came home to me in a very personal way when I was diagnosed with prostate cancer. Because I live in a country with a free-market health-care system, I had a choice of treatments: surgery, external radiation, brachytherapy. I was able to find the doctor and hospital I felt most comfortable with. As a result, I can expect to live a long, healthy, cancer-free life. If I lived elsewhere, this might not have been the outcome. In most countries with national health insurance, the preferred treatment for prostate cancer is ... to do nothing.

Prostate cancer is a slow-moving disease. Most patients are older and will live several years after diagnosis. So it is not cost-effective under socialized medicine to treat the disease too aggressively. This saves money, but at a more human cost. Though American men are more likely to be diagnosed with prostate cancer than their counterparts in other countries, we are less likely to die from the disease. Less than 1 in 5 American men with prostate cancer will die from it, but 57 percent of British men and nearly half of French and German men will. Even in Canada, a quarter of men diagnosed with prostate cancer die from the disease.

The one common characteristic of all national health-care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration more indirectly, imposing global budgets or other cost constraints that limit availability of high-tech medical equipment or impose long waits for treatments. Consider this: 7 in 10 Canadian provinces report sending prostate cancer patients to the United States for radiation treatment. In Great Britain, roughly 40 percent of cancer patients never get to see an oncologist.

There are problems with the American health-care system. Too many Americans lack health insurance and/or are unable to afford the type of care I received. We need to do more to lower health-care costs and increase access. Both patients and providers need better and more useful information. The system is riddled with waste and the quality uneven. Government health-care programs like Medicare and Medicaid threaten future generations with enormous debt and taxes.

Yet we should never forget that America offers the world's highest-quality health care. Most of the world's top doctors, hospitals and research facilities are in the United States. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. Half of all the major new medicines introduced worldwide in the last 20 years were developed by U.S. companies. Americans played a key role in 80 percent of the most important medical advances of the last 30 years. By almost any measure, if you are diagnosed with a serious illness, the United States is where you want to receive treatment. That is why tens of thousands of patients from around the world come here every year.

The guiding principle of health-care reform should be the Hippocratic admonition, "First do no harm." Those calling for national health care in America would destroy the things that make American health care so good. More regulation, subsidies and control would simply drain the medical market of the quality, dynamism and innovation that saves lives.

What American health care needs is more choice and competition, not less. We've started down that route through Health Savings Accounts and other market-oriented reforms, but more needs to be done. My Cato colleague, Michael Cannon, and I recently published a new book, Healthy Competition: What's Holding Back American Health Care and How to Free It, outlining comprehensive market-oriented reforms that would make health care more affordable, expand consumer choice, and preserve the quality of care. We hope it will serve as a starting point in the political debate to come. But, for now, I for one say, God bless American health care.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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9 October, 2005

HOW AWFUL: THE BEST DRUG FOR SCHIZOPHRENIA ALSO HAS THE MOST SIDE-EFFECTS

When you find a drug with no side effects, you will also usually have found a drug with no main effects either. Patients should of course always be warned of common side-effects but that should be the end of it. Side effects will always be with us for the foreseeable future. You cannot regulate them away

"The biggest-ever study of treatments for schizophrenia emphasizes how difficult the disease, which afflicts 3.4 million Americans, is to treat, and how often patients fail to experience relief from the first drug they try. Eli Lilly's Zyprexa was the most effective drug in the trial, but its victory was dulled by the medicine's side effects, and by the fact that Zyprexa was given in doses higher than are allowed on its prescribing label, while the other drugs were not.

Three times out of four, patients could not get satisfaction from the first drug they were prescribed in the study. They tended to switch either because of side effects, such as severe weight gain or neurological tremors, or because the drugs didn't ease the delusions, hallucinations and emotional numbness that can cripple schizophrenia patients. "These treatments are effective--there's no doubt about that," says Jeffrey Lieberman, chairman of the department of psychiatry at Columbia University and director of the New York State Psychiatric Institute, who designed and ran the trial. "But the glass is only half full."

The data from the study, called the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), could also send shock waves through the $14 billion market for antipsychotic drugs. The CATIE results were released at a press conference by the National Institute of Mental Health, which funded the trial. As first reported on Forbes.com last Friday, the results will be published in Thursday's New England Journal of Medicine. The results of the study closely mirror what was predicted here last week

CATIE hands a major victory to Zyprexa, the top-selling drug for Eli Lilly, which has been losing market share in the U.S. Some 64% of patients on Zyprexa were switched to another drug, compared with 75% or more of the patients taking the other drugs. "I don't think people were ready for this," says Leslie Citrome, a professor of psychiatry at the New York University School of Medicine, who did not participate in the study. "I think people were ready to bury [Zyprexa]."

But the data are a double-edged sword for Lilly, because they also show that Zyprexa causes more weight gain, high blood sugar and raised cholesterol than its competitors do. By comparison, patients taking Pfizer's Geodon, on average, experienced no weight gain and fewer of the neurological tremors that can be a serious problem for schizophrenia patients. Lieberman, who headed up the study, agreed that Pfizer now might have grounds to say its drug has milder side effects. Worries about changes in heart rhythm that had plagued Geodon after it was approved did not turn up in CATIE. But 79% of patients switched off of Geodon, so for the sickest patients, physicians may want to turn to the more powerful drugs.

One clear message from the trial is that the medicine that is right for one patient may not be right, in terms of either effectiveness or side effects, for another. One surprise for many was that the drug perphenazine, an antipsychotic that was discovered in the 1950s and is now a dirt-cheap generic, did as well as the other drugs. Symptoms of tardive dyskinesia, a kind of involuntary movement, didn't show up in the study. However, such neurological side effects can take years to develop, as in the case of jazz musician Tom Harrell, who experienced severe neurological symptoms after years on one of the older drugs. He was eventually switched to Zyprexa, which caused weight gain, and then to AstraZeneca's Seroquel, another drug used in the CATIE study. Once he found the right drug for him, he actually lost weight, and his symptoms were well controlled

One big question that remains is whether Zyprexa would have done as well if it had been given in the doses for which the drug was approved, as the other drugs in the study were. In actual practice, schizophrenia drugs tend to be given in doses higher than the approved levels. According to Lieberman, the investigators approached the makers of all the drugs being used in CATIE with proposed dose ranges that went above what the U.S. Food and Drug Administration had approved.

However, Lieberman says, only Lilly agreed to provide its drug to CATIE investigators at the higher doses. Pfizer, AstraZeneca and Johnson & Johnson, which makes Risperdal, did not want to use the higher doses. Astra and Lilly do not dispute that account; the other companies could not be reached for comment.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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8 October, 2005

CALIFORNIA LOCAL POLITICIANS OBSTRUCT PRIVATE HOSPITALS

In an unusual move that has rocked the local hospital community, the Sacramento City Council is poised to stretch its approval authority over construction projects to include the way large medical facilities spend money and care for patients. Under the plan, the council would go beyond a typical examination of whether a proposed medical facility poses environmental, traffic or other impacts. Added to its considerations would be nine "community benefit principles" that range from collection practices to labor issues. The plan was drafted by a coalition of religious leaders, social-justice activists and representatives from the Service Employees International Union and the Sacramento Central Labor Council.

Steve Cohn, one of four City Council members bringing the issue for a vote Thursday evening, said he supports the coalition's push for equitable health care. Council members Rob Fong, Lauren Hammond and Kevin McCarty also have attached their names to the resolution. "These (hospitals) are nonprofits that pay the city no property tax," Cohn said. "There is a notion that they should be held to a certain standard to provide benefits to the entire community - that's what's driving this." Cohn said he is confident that there will be enough support in the nine-member council to pass the resolution, which would serve as a legal guideline. However, he said he was not certain there was support to pass the plan as an ordinance.

Hospital and Sacramento Metropolitan Chamber of Commerce officials said hospitals already are regulated by state and federal agencies. "Our greatest fear is that there may be an additional delay of projects currently in the system at a time when Sacramento has near the lowest number of acute hospital beds per capita (in the state)," said Scott Seamons, regional vice president of the Hospital Council of Northern and Central California. The Sacramento chamber board Tuesday night voted unanimously to "strongly oppose" the community-benefit principles, its president, Matt Mahood, said. "The council should stay out of the health care business," Mahood said. "This resolution has the potential to make certain any future hospital developments will not be done in the city of Sacramento. They'll take them to other jurisdictions." .....

The Hospital Council has taken a position that the entire resolution is ambiguous and needs further study. Seamons said his group is willing to work with the city on ways to meet health care access objectives.....

Cohn said the principles could also come into play when the City Council examines a proposal by Mercy General Hospital to build a heart center and parking project in east Sacramento. Neighbors have said that the project is too large and creates too much traffic. An adjacent school opposes the project, saying it poses a health risk and nuisance. Mary Beth Teselle, a Mercy spokeswoman, said "it was too early to speculate what (the resolution) could mean" for its planned project and declined further comment.

Other principles included in the resolution call for hospitals to: maintain fair pricing guidelines, meet minimum quality care standards and provide an adequate level of care for residents in all neighborhoods as well as charity care. It also requires reasonable collection practices when patients are unable to pay their bills and says hospitals must agree to hold community meetings to discuss uses for abandoned hospital sites. An oversight committee would ensure compliance.

Harold Lawrence, president of Sacramento Area Congregations Together and a member of the coalition said the group will push the council to enact a stricter ordinance - not a simple resolution - that will "shine the light" on the way any nonprofit hospital does business. "That's the only way you're going to bring these entities to the table with the folks that really need health care services in the community," Lawrence said. "Finally we'll get them to answer things that they're very reluctant to talk about."

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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7 October, 2005

LOUISIANA HEALTH CARE IN THE SPOTLIGHT

An opportunity for real reform

Even before the hurricane hit, Louisiana had the second-highest uninsured rate, one of the least innovative Medicaid programs, one of the region's highest per-capita Medicaid and Medicare costs, some of the worst patient outcomes, and was the only state in the nation to own and operate a network of charity hospitals. Although these New Orleans-area hospitals were an important part of the medical community — a training ground for the state's health-care professionals and a source of specialized trauma care — they more and more often were diverting patients due to a lack of facilities and staff, and were in many areas barely clinging on to accreditation.

We are now faced with an enormous challenge to rebuild a city. In the wake of this challenge it is crucial to rebuild a health-care infrastructure by providing financial and regulatory relief to our health-care providers, and ensuring that Louisianans have access to personalized health-care services. We can, and should, be innovative in our thinking, turning New Orleans new health-care system into the model for the rest of the country.

According to press reports, a volunteer physician from Pennsylvania rushed to the New Orleans area to help the lone doctor performing triage at a makeshift center put together at the airport. While administering chest compressions to a dying woman days after Hurricane Katrina struck Louisiana, this physician was ordered to stop treating patients since he was not registered with the bureaucracy sitting in Baton Rouge and thus could cause legal-liability issues. The misguided concern over potential lawsuits prevented this physician from using his skills to save lives.

This is another example of how bureaucracy and red-tape fails to meet the critical needs of the American people. Everyday, in less dramatic fashion, bureaucracy impedes the delivery of high-quality health care. The American Hospital Association estimates that nurses in many settings spend an hour filling out paperwork for every hour they deliver care, while the head of the Mayo Clinic once estimated there were 130,000 pages of rules and regulations in the Medicare program alone. It is critical to ask: Who do we want to be in charge of making health-care decisions? Do we want the same bureaucracy that botched initial relief efforts? Or empowered patients working with their physicians to personalize health-care needs?

We must have consumer-driven health care which allows each patient to make the best choices for their individual needs. A one-size-fits-all approach is not the best way to meet the individual needs of families impacted by the storm. Enabling individuals and families to have this kind of personal ownership over their plans will ensure that those dislocated by Katrina have immediate health care. It will also provide portable benefits so individuals impacted by the hurricane can bring their health-care coverage back with them to Louisiana or other affected regions.

Before Hurricane Katrina, too many of our people in Louisiana received their non-emergency care in emergency rooms due to a lack of access to other affordable services. As we rebuild, we should concentrate on increasing access to out-patient and primary care. This should include making private insurance more affordable. Refundable tax credits, new insurance products including health-reimbursement arrangements and health-savings accounts, state-run purchasing pools, and regulatory relief must be provided to make it easier for individuals to purchase private coverage. In the short term, refundable tax credits can be offered to make COBRA and private insurance coverage more affordable.

One of the quickest and most affordable ways of increasing access to high-quality affordable care is to provide families with jobs that provide employer-sponsored health-care benefits. Workforce training, aggressive tax relief, perhaps including suspension of capital gains and income taxes, regulatory relief, and other incentives must be provided to encourage the creation of jobs for individuals impacted by Hurricane Katrina.

More here



Tough Medicaid choices ahead for Congress: "After a quiet August in Washington as members of Congress returned to their states and districts, the Capitol roared back to life in September because of budgetary deadlines. Congress continues to explore how it will come up with budget savings. Prominent on the chopping block is Medicaid, the largest of all federal health programs. The Hill and leagues of lobbyists are galvanized as Congress works to put a slight dent in future Medicaid growth. Medicaid began 40 years ago to serve as a safety net for the very poor. The first year's cost was $1.3 billion in combined state and federal government expenditures. In 2005, the program will cost $329 billion ..."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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6 October, 2005

GOVERNMENT HEALTH INSURER WON'T COUGH UP SO PATIENT HAS TO TAKE GOVERNMENT TO COURT!

A grandmother went to the European Court of Justice yesterday to demand that the Government pay for an urgent hip operation which she had carried out in a private French hospital. Yvonne Watts, 74, had been promised a reduced waiting time for treatment from a year to three to four months under the NHS. But she was in such pain from severe arthritis that she spent almost £4,000 on surgery in France. In the first case of its kind involving the NHS to be challenged under EU law, Mrs Watts’s lawyer told judges in Luxembourg that Bedford Primary Care Trust should pay for the operation.

The Department of Health argues that if all NHS patients were guaranteed repayment when they opted to seek treatment abroad, it could create inequalities in the health service. Her lawyer told the court that the trust insisted that Mrs Watts could receive treatment in a reasonable time in line with government targets and her general state of health. But she was entitled under EU rules on free movement to travel anywhere within the EU if she faced an “undue delay” in treatment at home, the court heard.

Mrs Watts has already won a hollow victory in the High Court, which agreed she should be reimbursed “in principle”, but said that she had not faced an unacceptable wait under the NHS, once the original year-long wait for treatment was reduced to three to four months. The EU judges were told yesterday that Mrs Watts had decided to see a French consultant about her hips in January 2003, after being told that she would have a year-long wait for NHS treatment. The advice in France was that her need for an operation was becoming more urgent as her health declined.

A few weeks later she saw a British consultant who recommended that she be moved up the NHS waiting list to receive surgery within three to four months. But Mrs Watts wanted even swifter treatment abroad and asked Bedford Primary Care Trust to reconsider its earlier refusal to authorise such treatment. When authorisation was refused on February 4 she decided to go to France anyway, receiving the necessary surgery in Abbeville a month later, on March 7.

Mrs Watts’s daughter, Julie Harding, said yesterday that they could not rely on the trust being able to carry out the operation within three or four months. She said: “We simply didn’t believe that even in three or four months she would have the operation, because operations are often cancelled three or four times.” Ms Harding said that the case would settle the issue of whether healthcare providers can make decisions on how quickly they must offer treatment based purely on their budgets and the length of their waiting lists, or whether their overriding concern must be the suffering of the individual patient.

Lawyers representing the Department of Health told the court that if all patients were guaranteed reimbursement under these circumstances, the NHS system of administering medical priorities through waiting lists would be undermined. The net result would be the diverting of NHS resources to pay for less urgent treatment for those who are willing to travel abroad, discriminating against others not wishing or unable to go to another country for treatment, the court heard.

The European Court of Justice has addressed challenges from individuals fighting private insurers who refused to pay for treatment abroad, but has never before been asked to rule in a case involving a state-funded service in the EU where the full cost is normally borne by the authorities. It will not rule until next year.

Source



BUREAUCRAT THREATENS DOCTOR

A surgeon who worked at Bundaberg Base Hospital in south-east Queensland was told his career could be at risk if he quit in protest about hospital conditions, an inquiry has heard. Dr Sam Baker told the Queensland public hospitals inquiry today the alleged threat came from the then director-general of Queensland Health, Dr Rob Stable.

In 2001, Dr Baker wrote to the then Bundaberg district manager Peter Leck, outlining his concerns about cancellation of elective surgery, cutbacks in nursing staff, rusty operating theatre equipment, and high levels of rotation in doctors' rosters. He said Mr Leck called him to a meeting, saying Dr Stable was "not happy" about embarrassment created by a newspaper report on doctors leaving the hospital. Dr Baker said Mr Leck had told him Dr Stable had warned his career could be "affected or damaged".

Dr Baker told the inquiry the faulty equipment was later replaced and he withdrew his resignation, only to quit in frustration in November the following year. He said the hospital's administration was more concerned with its budget than its patients. "I became more than frustrated trying to do my job at the hospital due to lack of funding, lack of staffing," Dr Baker said. "I had concerns there were junior doctors unsupervised in the emergency ward overnight and they were making mistakes."

Mr Leck, who has been stood aside from his position as district manager at Bundaberg, is yet to take the witness stand. The inquiry has been examining circumstances surrounding the employment of Jayant Patel, the former director of surgery at Bundaberg Hospital who has been linked to the deaths of at least 80 former patients.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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5 October, 2005

BRITISH HEALTH AUTHORITIES AGREE TO GIVE LIFE-SAVING DRUGS -- BUT ONLY AFTER A HUGE PUBLICITY BATTLE

But no general precedent has been set. Too bad for you if you cannot get the ear of journalists

A nurse fighting breast cancer has won a legal battle with her health authority to be prescribed expensive life-saving drugs. Barbara Clark said she was absolutely delighted after health officials said that due to her exceptional circumstances she could now receive a course of Herceptin, which would have cost £40,000 privately. Ms Clark, 49, had vowed to take her case to the European Court of Human Rights if her application to the Somerset Coast Primary Care Trust had been unsuccesful.

The trust said that it had agreed to prescribe the drug — which has not yet been approved to fight the early stages of the disease — due to Ms Clark’s personal circumstances. She has a terminally ill 11-year-old foster son. After the trust backed down yesterday Ms Clark, who has two children, said she hoped the treatment would now be extended to other women in her position. She is currently in remission from the cancer after undergoing intense chemotherapy but her consultant has warned that the disease is likely to return within three or four months.

“I’m absolutely over the moon, this couldn’t be better news,” Ms Clark, who lives in Bridgwater, Somerset, said. “It can increase life expectancy by 52 per cent, which means I’ve got a better chance of spending more time with my children. “There’s a lot of women with exceptional need, everyone has the same need to life.”

Cancer charities welcomed the news and said the drug could make a difference to the lives of thousands of women. Clara MacKay, director of policy and research at Breast Cancer Care said: ““There is very clear evidence that Herceptin has the potential to make a huge difference to as many as 10,000 women in the UK every year following a diagnosis of breast cancer for the first time. “Yet despite Herceptin’s apparent benefits, most women continue to face an extremely long delay before the drug becomes widely available.” Joanne Rule, chief executive of charity CancerBACUP, added: “Now that one PCT has made Herceptin available to women with early breast cancer, the Department of Health must urgently consider making it available to all women who can benefit. The time to act is now.”

The Department of Health said the decision to fund Ms Clark’s treatment would not pave the way for other women to claim the treatment. The manufacturers of the drug, which has been prescribed to up to 40 women on the NHS after individual primary care trusts ruled they had “exceptional circumstances”, have not applied for a licence for the early use of the drug in this country. A spokeswoman for the DoH said: “The Government cannot dictate when drug companies apply for licence. “We must be sure that medicines are robustly tested and proved effective before they are made available to patients. The licensing process is important for patient safety. If and when it is licensed for early use, NHS bodies can prescribe Herceptin, but this must be a local decision

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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4 October, 2005

BRITAIN SACKS TOP DOCTORS TO BALANCE THE BOOKS

No amount of money is ever enough when you have got hungry bureaucrats to feed

NHS consultants have been threatened with redundancy, the first time this has happened for many years. The move by Oxfordshire Mental Healthcare NHS Trust is an indication of the extreme financial pressures being experienced by many parts of the health service despite several years of the most generous financial settlements it has ever enjoyed. The trust is not itself in deficit and won three stars in the most recent set of ratings issued by the Healthcare Commission. But it has been told to find efficiency savings of £3.3 million a year; has lost £1 million from the primary care trusts it serves; and has been asked to find another £1.65 million by Thames Valley Strategic Health Authority (SHA) to help other trusts in the area to balance their books. Faced with this final demand, the trust announced last week that seven consultants, seven senior house officers and one specialist registrar could lose their jobs.

The British Medical Association stepped in to try to prevent the redundancies and has been in discussion with the SHA. Jonathan Fielden, deputy chairman of the BMA consultants’ committee, said: “We have been saying for months that redundancies among medical staff were a risk. This is the first time it has actually been threatened. “As far as we are aware, the last time consultant redundancies were threatened in the NHS was over the Tomlinson report into hospital provision and medical training in London, and that was more than ten years ago.”

If implemented, the cuts at Oxfordshire Mental Healthcare Trust, which runs the Warneford Hospital in Headington, Littlemore Mental Health Centre, Park Hospital for Children and three other centres, would reduced its medical staff by 20 per cent. The announcement came as trusts across the country made plans to shed hundreds of jobs because of NHS cash problems. Despite the Government spending billions more on the service, some trusts have substantial debts, running collectively into hundreds of millions of pounds. Others are in surplus. Normally cash is shifted around from trust to trust to help to balance everybody’s books. In this case, the Oxfordshire trust — which has broken even for the past five years — said that if required to find the £1.65 million the SHA was demanding it could do so only by cutting jobs.

The trust and Dr Fielden are hopeful that a settlement that would not involve redundancies is still possible. “But the threat is still there,” he said yesterday. “It validates what we have been saying for months. “The news we are hearing from around the country is that the axe is being sharpened and many more jobs will go either directly or indirectly. “A lot of trusts are planning to make redundancies by stealth. They will avoid direct redundancies where they can. Oxfordshire Mental Health Trust is one of many that is having its bank balances raided to help those trusts that are in deep debt, some to the tune of tens of millions of pounds.”

He said that it was sad that psychiatric jobs were under threat, as patients with mental illnesses were often the most vulnerable in society and would undoubtedly suffer if doctors lost their jobs

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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3 October, 2005

DRUGGIE DOCTORS: THERE OUGHTA BE A LAW....

Of course there already are plenty of laws against drug abuse, by doctors as well as by everybody else -- but such laws contantly fail to achieve anything beneficial. There is no substitute for openness of information, a non-punitive approach and supervision by those with a financial interest in good practice

There's a joke doing the rounds of Sydney's medical fraternity following the high-profile case of Timothy Steel, the brain surgeon who appeared in court last week on cocaine possession charges. It goes like this: what do you do if you're a visiting medical officer at one of the landmark Sydney hospitals where Steel works. Answer: follow the white line.

Like many good jokes, this one has an extra edge because it touches a nerve. As the doctors who have been sharing this witticism know, and knew long before Steel's name hit the headlines, drug-taking within the medical profession is a real issue for a minority of its more stressed-out members. "I don't think you can possibly estimate (the numbers of doctors taking drugs), because the difficulty is this is happening without people knowing about it," says Narelle Shadbolt, a GP and lecturer in general practice at the University of Sydney. "Doctors have high rates of stress-related illnesses such as depression, anxiety, work-related stress, marital and work relationship problems - and the end result of that is drug addiction and suicide."

Shadbolt is in a position to know: she's president of the NSW Doctors' Health Advisory Service, a voluntary service set up some 22 years ago by doctors who saw a need for a confidential advice service for medical professionals in distress. There are similar services in every state and territory, catering for this numerically small but significant problem. The NSW one gets about 100 calls a year. "Doctors tend to be a group of people who are high achievers, perfectionist and have a very strong work ethic. Those of course place you at risk of stressrelated illness," she says.

The contrast with the general public is poignant: doctors have lower rates of lifestyle illnesses, such as smoking-related diseases and heart disease. But despite this their jobs can still exact a heavy toll. Shadbolt says rates of depression among doctors are two to three times higher than among the general population; alcohol and drug abuse is about two to three times higher; and the suicide rate is about three times higher. For those experiencing high levels of stress, the risk of substance abuse may be higher because doctors have a lot of knowledge about drugs, and also can get hold of them much more easily than most members of the public.

But having a greater knowledge about a drug's effects can leave some doctors with the dangerous and wrong idea that they can use a drug safely, Shadbolt says. "Doctors do believe they can keep it under control, and that's a very false belief." Simon Willcock, Shadbolt's predecessor as president of the Doctors' Health Advisory Service, says when a call comes in, about half of the time it's from the doctors themselves; in other cases it's a work colleague, or more rarely a spouse or relative....

Willcock gives presentations on doctors' health issues and says previous taboos on a doctor reporting another have largely disappeared. "When I talk to doctors about these sorts of things, I put it in three contexts. One is that it's a stressful environment that we work in; yes, we work under stress and that can push us towards a threshold where we behave inappropriately, such as using illicit drugs, and it can affect your relationships," he says. "But the next thing I then go on to say is that individuals need to take responsibility and know what these thresholds are, and destress and take their down time - and that's something doctors aren't good at. "The third thing is that the medical community needs to take responsibility (and identify colleagues). "That's the controversial one, because do you dob in someone you are worried about.

"I think doctors increasingly recognise that to talk to the DHAS about someonethey are worried about is in fact in that person's interests - it's more likely to help them in their career than hinder them in their career."

More -- much more -- here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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2 October, 2005

AH! THE PAIN! WITH A PUBLIC MEDICINE SYSTEM NO MONEY IS EVER ENOUGH

Those bureaucrats are expensive! But there are SOME sensible suggestions for change to the Queensland system in the latest report on it

The Beattie Government must find almost $400 from each person in Queensland each year to fix the ailing health system in line with Peter Forster's blueprint for reform. In his 429-page final report on the health system, Mr Forster said he was shocked at what he had found and recommended sweeping changes to the staffing, structure and service delivery of Queensland Health. He said the State Government had significantly under-funded health care. It should now consider raising taxes, introducing means tests, reviewing increased patient fees and encouraging people to take better care of themselves.

Mr Forster also said Queensland Health should ration or withdraw from some services. The report recommended that hundreds of Queensland Health head office staff be sacked or transferred to regional centres. And it called for an additional 280 doctors and 1500 nurses.

Mr Forster said the Government should be honest about the cost of health care delivery and the performance of Queensland Health. He recommended six-monthly reports on the true state of waiting lists, which had been under-estimated by almost 50 per cent. Accepting the report yesterday, Premier Peter Beattie and Health Minister Stephen Robertson estimated the cost of reforms would be $1.5 billion a year. Spread across Queensland's population, which is tipped to reach four million late this year, this equates to $375 a person in new taxes or charges, or a reduction in existing services.

Mr Beattie previously had promised money from last year's $3 billion Budget surplus for health reforms. But with large amounts of that money needed for public servants' superannuation, and with the surplus projected to decline to $220 million in 2008-09, Mr Beattie yesterday admitted there would be pain in paying to fix health. He had not yet decided to raise taxes or introduce new charges, but said the cost of the reforms meant the Government would have to find new ways of funding hospitals. "The current surplus is not sufficient to deal with all the $1.5 billion additional expenses," Mr Beattie said.

He pledged to maintain the essence of the free hospital system but to also consider the Forster recommendations for co-payments and means testing at public hospitals. Mr Beattie admitted the report was "a serious indictment on a range of governments, including mine". He said the poor funding of hospitals had come about through a combination of Queensland's traditionally low taxes and its high population growth.

Mr Forster said that Queenslanders needed to realise they could not continue to have low taxes if they wanted leading-edge health services, adding: "We've now got to make decisions as a society." He said a better funding agreement was needed between the state and commonwealth governments. As well, the state could consider buying private health insurance for Queenslanders who could not afford it. .....

Mr Springborg said Mr Forster had missed the opportunity to implement serious reform of the health bureaucracy. He predicted that the system eventually would settle back to exactly what it had been before. "All they've done is rearrange the bureaucracy and you've still got the same problems – four times as many bureaucrats and administrators as doctors and nurses."

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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1 October, 2005

LEFTIST BUCKPASSING FALLS FLAT

An ATTORNEY performed a statistical analysis? How about a statistician, a mathematician, an economist, an accountant or an actuary?

Independent actuaries with the firm Towers Perrin find that a July 2005 report released by the Center for Justice and Democracy and five other "consumer groups" is incomplete and unsound. Jay Angoff, an attorney employed by a personal injury law firm, performed the analysis for the six "consumer groups" and claimed that medical liability insurers have overcharged doctors and hospitals and accumulated record amounts of surplus over the last three years.

However, an analysis of Angoff's report by actuaries James Hurley and Gail Tverberg finds that those claims are not supported by the data, nor do they pass a common sense test. Towers Perrin's comments released today find Angoff's "analysis is incomplete and unsound" and his statistics "are:

1) meaningless and unsound in the case of paid loss to written premium comparisons;

2) materially incomplete, in the case of incurred loss to earned premium comparisons; or

3) incomplete and taken out of context, in the case of the change in surplus."

The Towers Perrin analysis documents that malpractice insurers have lost money in each of the years 1999 through 2003 even after considering investment income from their bond portfolios. In 2001, financial results were the worst in approximately 30 years. Hurley and Tverberg, through a succinct and thorough review, demonstrate that Angoff's conclusions cannot be supported by the facts.

Furthermore, Hurley and Tverberg find that Angoff's analysis fails the common sense test in that insurance regulators and analysts do not look at the statistics that Angoff derives because they are "meaningless, incomplete and inappropriate to form the conclusions made in the [Angoff] Report. If medical malpractice is as profitable as implied by the report, more companies would be competing to write the coverage."

PIAA President Larry Smarr applauded the actuaries' comments. "The Angoff report is a hoax and inappropriately twists numbers to claim that medical malpractice insurers have increased premiums at a rate more than 20 times the increase in claims payments. Towers Perrin has taken a critical step toward setting the record straight and stopping Angoff and these groups from further misleading the public."

Mr. Angoff's report is entitled, "Falling Claims and Rising Premiums in the Medical Malpractice Industry." The PIAA is an association of doctor/provider owned and/or operated medical liability insurance companies which insure over 60 percent of America's private practicing physicians as well as dentists, hospitals, and other healthcare providers.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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